Soft-tissue profile changes in adult patients treated with premolar extractions.

INTRODUCTION: The objective of this study was to identify the soft-tissue profile changes and the potential pretreatment cephalometric parameters that clinicians could use to predict the lip response after premolar extraction treatment in adult patients. METHODS: Pretreatment and posttreatment lateral cephalograms of 75 white patients treated with premolar extractions were analyzed. The following initial cephalometric measurements were recorded: upper and lower lip to E-plane, vermilion thickness, lip length, maxillary and mandibular incisor inclination, and mentolabial and nasolabial angle. Pretreatment and posttreatment radiographs were superimposed using the Björk structural method to record lip retraction and incisor/lip retraction ratio. Pearson correlation and Kruskal-Wallis tests were used to compare lip retraction and incisor/lip retraction ratio with the cephalometric variables. The sample was divided according to different extraction patterns. RESULTS: The mean upper and lower lip retraction values were 1.4 mm and 1.7 mm, respectively. Vermilion thickness showed a negative and statistically significant correlation (P <0.05) with lip retraction and incisor/lip retraction ratio. In addition, the mean incisor/lip retraction ratio was 61% and 98% for the upper and lower thin lip, respectively, whereas the mean incisor/lip retraction ratio was 17% and 44% for the upper and lower thick lip, respectively. The comparison among extraction patterns did not highlight any noticeable difference. CONCLUSIONS: The choice of a specific extraction pattern did not impact lip response. The vermilion thickness was the key factor influencing lip retraction: an increase in this parameter was related to a decrease in lip retraction and vice versa.

Nonsurgical treatment of an adult patient with severe transversal skeletal discrepancy: Tooth bone-borne tandem expander and hybrid aligner approach.

BACKGROUND: Although they have proven effective in the resolution of mild to moderate malocclusions, aligners demonstrate substantial limitations. More complex malocclusions therefore require a combination of auxiliaries, or a hybrid approach involving both aligners and fixed appliances, such as miniscrew-supported appliances or sectionals. This case report presents a 25-year-old female patient with a severe transversal discrepancy associated with an anterior open-bite tendency effectively treated with a tooth bone-borne palatal expander characterized by two expansion screws (tandem expander) and a hybrid treatment with aligners. METHODS: After accurate matching between the pretreatment cone-beam computed tomography scan and digital models, four self-drilling miniscrews were inserted palatally using a computer- aided design and computer-aided manufacturing surgical template to guide their correct and safe placement, and a tooth bone-borne appliance was fitted. After this first phase, the hybrid clear aligner approach was used to obtain alignment, leveling, and arch coordination, with the use of a partial lingual fixed appliance. RESULTS: Transverse maxillary deficiency was corrected, crowding has been resolved, Class I molar and canine relationship were obtained, and marginal ridges has been aligned. CONCLUSIONS: Double jackscrew of the tandem expander enabled effective expansion of both the posterior segments as required to correct the skeletal discrepancy and the anterior region, thus relieving the dental crowding. Lingual sectional appliances have been shown to increase the effectiveness of clear aligners which, on the other hand, have been shown to be effective in closing the anterior bite by retroclination of the maxillary and mandibular incisors and, only minimally, by extrusion movements.

Effectiveness of Mandibular Advancement Devices in Positional OSA Patients: A Retrospective Analysis of Predictive Variables in a Sample of Adult Patients.

Objectives To evaluate the efficacy of mandibular advancement devices (MADs) in improving apnea-hypopnea index (AHI) in positional obstructive sleep apnea (POSA), compared with a control group of nonpositional OSA (NPOSA) patients, from mild to very severe degree, in order to to find the main variables characterizing the examined group as potential predictors of treatment success. Materials and Methods In the present observational study, we retrospectively collected polysomnographic records of 39 positional adult patients, divided into 30 supine isolated OSA (siOSA) and 9 supine predominant OSA (spOSA) undergoing MADs from 2003 to 2019, and compared with those of a control group of 47 NPOSA patients. Demographics and anthropometrical data, home sleep apnea test (HSAT) records, drug-induced sleep endoscopy (DISE) results, and dental casts evaluation were analyzed pre- and post-treatment with MADs. Results A prevalence of the male sex (86%), mean age of 49,4 ± 14.98 years, and mean body mass index (BMI) of 26.74 ± 4.29 kg/m 2 were found among the OSA patients with significant differences between the three groups for sex and BMI. After MADs, the HSAT revealed significant reduction of AHI in all of the groups, with greater reduction of the supine AHI in POSA and significant reduction of the snore index for NPOSA. The hypopharynx section (H) of the NOHL Index, a fourth degree of hypopharyngeal collapse and an anteroposterior pattern was the most frequent to occur (19.9%) from DISE exam. No significant correlation between the initial total AHI and the dental variables was found, except for a reduced maxillary intermolar distance. Conclusion MADs are effective in reducing AHI in POSA and NPOSA patients from mild to very severe degree. Supine AHI decreased after treatment with MADs mainly in siOSA and spOSA patients compared with the NPOSA group. The snore index decreased significantly after treatment with MADs in all groups, showing the greater reduction in the NPOSA group. The tongue base (H) represented the most frequent anatomic area of collapse and there was a high prevalence of upper maxillary constriction.

Monotherapy with P2Y12-inhibitors after dual antiplatelet therapy: Filling gaps in evidence.

BACKGROUND: Whether P2Y12 inhibitor monotherapy (P2Y12-I) is superior to aspirin following DAPT discontinuation post-PCI remains to be established. METHODS: We updated our prior network meta-analysis where P2Y12-I and aspirin had been compared with DAPT or directly with each other. The focus is specifically on the available direct evidence, now consisting of the three head-to-head comparisons of P2Y12-I and aspirin in event-free PCI patients after DAPT. We include a Trial Sequential Analysis of the direct evidence based on meta-analytical literature. RESULTS: The main finding reveals a 39% significantly lower risk of myocardial infarction with P2Y12-I (RR 0.61, 95% CI 0.47-0.78, p = 0.0001, I2 = 0%) with no difference in bleeding. Trial Sequential Analysis demonstrates clinically meaningful evidence for a reduction in the incidence of myocardial infarction with P2Y12-I that is also supported by statistical significance. CONCLUSIONS: Accruing data highlight that P2Y12-I following DAPT discontinuation after PCI is associated with lower risk for MI and a similar risk for bleeding as compared with ASA. In light of potential limitations to the widespread adoption of life-long P2Y12-I treatment, clinicians should consider identifying selected patients who are expected to derive the highest benefit.

Non-compliance treatment in a young adult full-step class II division 2 malocclusion with preadjusted lingual appliance and upper first molars extractions.

This case report describes a complex full-step class II case in a young adult patient treated with lingual straight-wire appliance and upper first molar extraction. As the patient refused a surgical treatment, she was offered the best possible camouflage with the double aim of obtaining an ideal occlusal relationship and maintaining the profile; appropriate biomechanical strategies, including extraction choice and anchorage control during space closure, were needed to achieve the planned results. This case report demonstrates the possibility of successfully resolving severe sagittal discrepancies in an adult patient without surgical treatment by means of a completely invisible non-compliance technique, with the extraction of the most compromised teeth. This report also underlines the need for careful planning during both diagnostic and treatment phases, in order to obtain the best results.

Evaluation of effects of brackets and orthodontic wires on intraoral scans: A prospective in-vivo study.

OBJECTIVE: To evaluate any distortion produced by multibracket fixed orthodontic appliances on digital models obtained from intraoral scans (IOS), considering the presence of both brackets only and brackets/archwire combination. SETTING/SAMPLE: The IOS data of the arches of 20 patients (12 females and 8 males; mean age = 15.55 ± 2.84 years) were acquired using the CS3600 intraoral scanner (Carestream Dental, Atlanta, USA), without any appliances (model A), with vestibular brackets alone (model B) and then with brackets and orthodontic archwire fitted (model C). MATERIALS AND METHODS: Data were acquired between the months of January and October 2021 at the moment of indirect bonding phase. On each model, five intra-arch linear measurements were obtained (inter-canine, inter-premolar 1 and 2, inter-molar and arch depth), and after digital matching between model A and B (match 1) and A and C (match 2), the linear discrepancies were evaluated at 20 points (10 occlusal and 10 gingivolingual) previous identified on the reference model A. All measurements were performed using Geomagic Control X software (3D Systems, Morrisville, USA), and any dimensional variations and distortions were evaluated by the linear regression analysis and two-sample t-test (P ≤ .05). RESULTS: The results show an almost perfect correlation between both models B and C and the reference model A, both as regards the intra-arch linear measurements and the linear discrepancies found at the 20 identified points. CONCLUSIONS: Multibracket fixed orthodontic appliances do not produce any relevant distortions in digital models obtained via intraoral scanning. Therefore, the removal of archwire is not mandatory before IOS.

Invisible treatment with lingual appliance for the correction of an adult class II subdivision with asymmetrical Wilson and Spee curves: A case report.

This article describes a class II subdivision malocclusion successfully treated by an invisible lingual appliance. The combination of en-masse distalization by interradicular palatal mini-screws and inner unilateral class II auxiliaries, first by intermaxillary elastic, later by a class II coil spring, resulted in a dento-alveolar correction, allowing one to maintain the appliance completely invisible. At the same time, the inclination of buccal sectors was normalized by a correct torque expression with set-up overcorrections, resulting in a significant improvement of the buccal corridors. This case report demonstrates the possibility of successfully solving class II division 2 subdivision malocclusion in adult patients without surgery by means of a completely invisible appliance. It also demonstrates that correct levelling and torque expression, for the correction of asymmetrical Spee and Wilson curves, are achievable with an accurate set-up planning. On the other hand, it underlines the necessity of mini-screws, auxiliaries and set-up overcorrections in order to obtain the best results.

CAD/CAM-based 3D-printed and PVS indirect bonding jig system accuracy: a systematic review, meta-analysis, and comparative analysis of hard and soft CAD/CAM transfer trays.

BACKGROUND: The widespread use of CAD/CAM transfer trays warrants evaluation of their accuracy as compared to PVS transfer trays. OBJECTIVES: To quantify the accuracy of CAD/CAM and PVS transfer trays, investigating any differences between soft and hard trays CAD/CAM transfer trays. SEARCH METHODS: Eight different databases (Scopus, Web of Science, PubMed, Google Scholar, ProQuest, Embase, Cochrane Library, ClinicalTrials.gov) were searched, without restrictions, up to an end date of February 2023. SELECTION CRITERIA: Clinical trials (randomized and non-randomized) and in vitro studies reporting average imprecision values for bracket positioning obtained by digital superimpositions of digitally planned and real positions. DATA COLLECTION AND ANALYSIS: Data eligibility, data extraction, and risk of bias (RoB-2 and ROBINS-I) were conducted independently. The data, where possible, were synthesized and quantitatively analysed (meta-analysis of mean differences with 95% confidence intervals). The Grade of Recommendation, Assessment, Development and Evaluation (GRADE) analysis of the quality of evidence was performed. The t-test for independent samples was used to compare the transfer accuracy of hard and soft CAD/CAM transfer trays. RESULTS: Thirteen studies were synthesized in this systematic review, and then eight studies were included in the quantitative meta-analysis. As regards linear measurements, there was a mean transfer error of 0.0752 mm (95%CI: 0.0428, 0.1076) for mesiodistal measures, 0.0943 mm (95%CI: 0.0402, 0.1484) for vertical, and 0.0815 mm (95%CI: 0.0469, 0.1160) for buccolingual. As for angular measurements, there was an average transfer error of 1.2279° (95% CI: 0.6011, 1.8548) for inclination, 0.9397° (95%CI: 0.4672, 1.4123) for angulation, and 0.8721° (95%CI: 0.4257, 1.3185) for rotation. CAD/CAM transfer trays were less accurate than polyvinylsiloxane (PVS) transfer trays, with those made of soft material being more accurate than the hard ones, except for vertical dimension. The GRADE quality of evidence ranged from very low to moderate. CONCLUSIONS AND IMPLICATIONS: CAD/CAM transfer trays provide high bracket positioning accuracy, with soft transfer trays offering greater precision than rigid ones. Future randomized prospective trials are required to enhance the strength of the available evidence. REGISTRATION: Prospero (CRD42023401278 number).

Accuracy of 3D facial scans: a comparison of three different scanning system in an in vivo study.

BACKGROUND: The aim of the study was to compare the accuracy and reproducibility of three different 3D facial scanning systems, relying, respectively, on stereophotogrammetry, structured light and a smartphone app and camera. METHODS: Thirty subjects have been scanned with three different facial scanning systems, stereophotogrammetry, structured light and a smartphone app and camera. Linear measurements were compared with direct anthropometries measured on the patient's face, while the study of areas (forehead, tip of the nose, chin, right and left cheek) was evaluated by overlapping scans using the Geomagic Control X program. Statistical analyses were conducted using IBM SPSS v28 software. RESULTS: The ANOVA test was used to compare linear distances and direct anthropometry measurements, revealing statically significant values for all distances investigated, especially for the Face Hunter scanner, except for the Prn-Pog' distance (p = 0.092). The three facial scans were superimposed pairwise almost the 100 per cent of the overlapping areas fell within the tolerance limits for all three comparisons analysed. The chin was the most accurately reproduced, with no differences among scanners, while the forehead proved to be the least accurately reproduced by all scanners. CONCLUSIONS: All three acquisition systems proved to be effective in capturing 3D images of the face, with the exception of the Face Hunter scanner, that produced statistically significant differences in linear measurements for the distances Tr-Na' and Zyg-Zyg with respect to direct anthropometric measurements.

Survival rate of indirectly bonded brackets using single vs. two-component orthodontic adhesive: A 12-month split-mouth clinical trial.

Objective: Compare the bonding survival rate of two distinct bonding materials: Ortho Solo + Gradia LoFlo Resin and single component GC Ortho Connect. Materials and Methods: Indirect bonding fixed appliance treatment was required for 26 consecutive patients, 8 males and 18 females, with a mean age of 22.1 +/- 4.2 years. All patients were treated with SWM (Straight-Wire Mirabella) technique (Sweden and Martina, Due Carrare, Padova, Italy). Each patient's bonding process followed a contralateral pattern. Firstly, a 37 % orthophosphoric acid etching gel was used for 20 s, subsequently the single or two components light-cured adhesives were applied through a split-mouth cross-arch procedure. The patients underwent a 12-month follow-up period and brackets failures were rebounded, but not further included in the study. Statistical analysis was performed to analyse the survival rate of the bonding materials and the influence of the variables, with a significant level of α = 0,05. Results: The GC Connect group was used on 349 teeth, while the Ortho Solo + Gradia group was used on 351 teeth, and the indirect debonding rate was respectively 17.5% and 12.8%. With respect to the total sample, statistically significant values were found for both sex and dental arch. The bracket's survival rate for incisors, canines, premolars and molars was not significant. However, a higher debonding rate was clinically appreciable in upper and lower molars. Conclusion: In a 12-months observation period, considering all maxillary and mandibular teeth the indirect survival rate for the group GC Ortho Connect and Ortho Solo + Gradia was respectively 82.5% and 87.2%. Although the difference was not significant, a pronounced tendency to debonding for the single component group was appreciable from a clinically point of view.

Evaluation of effectiveness and efficiency of fixed orthodontic treatment comparing standard and computer-aided design and manufacturing conventional bracket systems using indirect bonding for both: A retrospective study.

BACKGROUND: To compare the effectiveness and efficiency of orthodontic treatment (OT) with standard versus computer-aided design and computer-aided manufacturing (CAD/CAM) indirect bonding of conventional brackets. METHODS: This retrospective study examined two groups: standard indirect bonding group (12 males, 13 females; mean age 12.21 ± 0.52 years), and digital indirect bonding group (11 males, 14 females; mean age 12.76 ± 1.32 years), treated via a CAD/CAM indirect bonding system. Conventional brackets were used in both groups. Pretreatment and post-treatment records were acquired for all subjects. Weighted Peer Assessment Rating (W-PAR) index was used to assess the effectiveness of OT, in conjunction with five angular cephalometric measurements (ANB°, Sn-GoGn°, U1-PP°, IMPA° and FMA°) and comparatively analyzed using generalized mixed-effects models and post hoc test. Treatment efficiency was assessed in terms of the numbers of bracket repositionings, archwire bends, accidental bracket debondings, appointments and treatment months. Comparative analysis of efficiency was performed using the asymptotic Wilcoxon-Mann-Witney test. Statistical significance was set at 5%. RESULTS: Total W-PAR and W-PAR component scores decreased significantly during treatment for both groups and in a similar way. Cephalometric measures ANB° and IMPA° significantly decreased and increased, respectively. Significantly fewer bracket repositionings, number of appointments and treatment months were recorded in group digital indirect bonding. CONCLUSIONS: Although both methods investigated were effective to achieve good outcomes, CAD/CAM indirect bonding method increased the efficiency of OT, when conventional brackets are used.

Accuracy of lingual straight-wire orthodontic treatment with passive self-ligating brackets and square slot: a retrospective study.

OBJECTIVES: To investigate the accuracy of torque, tip and rotation and linear intra-arch movements yielded by passive self-ligating lingual straight-wire appliances with brackets featuring square slots. MATERIALS AND METHODS: Twenty-five adult Caucasian patients (16 females and 9 males; mean age 26.5 ± 4.3 years) with Class I or mild Class II head-to-head malocclusion were orthodontically treated via passive lingual self-ligating straight-wire appliances (ALIAS, Ormco, Orange, CA) with no extraction. Records were retrospectively analysed, and digital models of pre-treatment (T0), planned (T1) and achieved (T2) phase were acquired for both arches in each patient via an intraoral scanner (Medit I500 (iScan Medit, Seoul, Korea). VAM software (Vectra, Canfield Scientific, Fairfield, NJ, USA) was used to measure both angular values (torque, tip and rotation) and linear intra-arch widths (between canines, first and second premolars and first and second molars). Measurements were obtained for all the movements investigated for each tooth group (incisors, canines, premolars and molars), by arch (maxillary and mandibular) and for both arches at T0, T1 and T2. The accuracy of angular values was compared using Student's t-test against a hypothetical 100%, and among the various tooth groups by post-hoc tests. Transverse linear measurements were investigated by means of the non-parametric Friedman test. The significance threshold was set at 0.05. RESULTS: The mean accuracy of angular values was 77.25 ± 7.71% for torque, 78.41 ± 6.17% for tip and 77.99 ± 6.58% for rotation. In all cases, however, there was a significant difference between planned and achieved movements, and accuracy was significantly lower than the hypothetical 100% for all tooth groups, individual arches and dentition (p < 0.001). For intra-arch diameters, the greatest accuracy values were found for the anterior sectors (83.54 ± 5.19% for the maxillary inter-canine distance) and the lowest for the posterior sectors (67.28% for the maxillary inter-second molar distance). CONCLUSION: Straight-wire lingual treatment with passive self-ligating appliances featuring with square slot displayed excellent clinical accuracy, albeit with statistical accuracy decreasing antero-posteriorly.

Phenolic Extract from Olive Leaves as a Promising Endotherapeutic Treatment against Xylella fastidiosa in Naturally Infected Olea europaea (var. europaea) Trees.

(1) Background: Since 2013, the pathogenic bacterium Xylella fastidiosa has been severely affecting olive production in Apulia, Italy, with consequences for the economy, local culture, landscape and biodiversity. The production of a phenolic extract from fresh olive leaves was employed for endotherapeutic injection into naturally infected olive trees by Xylella fastidiosa in Apulia region, Italy. (2) Methods: The effectiveness of the extract was tested in vitro and in planta in comparison with analogous treatments based on garlic powder and potassium phosphite. (3) Results: The uptake of phenolic compounds from olive leaves through a trunk injection system device resulted in a statistically significant increase in leaf area index and leaf area density, as well as in the growth of newly formed healthy shoots. Plant growth-promoting effects were also observed for potassium phosphite. Moreover, the bacteriostatic activities of the phenolic extract and of the garlic-powder-based solution have been demonstrated in in vitro tests. (4) Conclusions: The results obtained and the contained costs of extraction make the endotherapeutic treatment with phenolic compounds a promising strategy for controlling X fastidiosa to be tested on a larger scale, although the experiments conducted in this study proved not to be suitable for centenary trees.

Profile changes in extraction treatments of upper premolars: A case series.

This case series describes the soft tissue changes following extraction treatment in two patients with diverse lip thickness, but with similar baseline parameters including: labial competence, soft tissue profile, patient's age, extraction protocol, methods of anchorage, malocclusion, crowding, treatment appliance and mechanics. The same treatment plan involved upper first premolar extractions and lingual appliance combined with skeletal anchorage. The lip thickness played a crucial role in these cases, since a similar change of the incisor position leads to a different profile variation. This difference could be explained by the differing initial lip thicknesses as the patient with thin lips showed a more pronounced profilometric change. The choice of the ideal treatment plan must be tailored to the individual patient, taking into account not only initial skeletal and dental factors but also soft tissue factors, as well as the treatment goals.

Obstructive Sleep Apnea in Developmental Age: 22-Item Pediatric Sleep Questionnaire for an Observational Descriptive Investigation.

The aim of this paper is to perform an observational descriptive study of the Obstructive Sleep Apnea Syndrome (OSAS) in a population of children by evaluating the prevalence and role of sex and age variables. The 22-item Pediatric Sleep Questionnaire (PSQ) was administered to parents of children aged 3 to 12 years. The questionnaire is a very simple tool since it allows for the indication of patients with possible OSAS diagnosis through a cut-off of 0.33. The anonymous diagnostic questionnaire, available in digital format, was administered to the population under study by a link or QR code. Only the questionnaires completed in all their parts were recorded and analyzed. Eight hundred and thirty-two questionnaires were collected. One hundred and fifty-four subjects obtained a PSQ score > 0.33 and the prevalence of OSAS was 18.51%. The Chi-square test showed a statistically significant association between the PSQ score > 0.33 and male sex. The higher prevalence of subjects with a value of PSQ > 0.33 (n = 277) are aged 3-4-5 years, followed by the 6-7-8 range in the group with PSQ score > 0.33, p < 0.05. The prevalence of OSAS was 18.51% in children aged 3 to 12 years. The variables male biological sex and the age group 3-8 year were statistically significant for subjects with OSAS diagnosis. This study underlines the use of the 22-item Pediatric Sleep Questionnaire as a first screening tool to identify children at risk of OSAS.

Is a non-radiological-assisted method valid for establishing crown-root relationships in an orthodontic set-up incorporating the roots? A retrospective study.

INTRODUCTION: This study aimed to obtain information on the relationship between crown and root in terms of morphology - dimensions and crown-root angles -to be used for orthodontic set-ups without the use of radiological examinations. MATERIAL AND METHODS: All the good quality CBCTs of patients obeying the eligibility criteria, from 2000 to 2015, were analysed. All teeth were analysed except for third molars. Six variables were evaluated: crown (CL) and root length (RL), crown width (CW), root width (RW), crown-root angles in both the frontal (CR-frontal) and sagittal plane (CR-sagittal). All teeth were divided into 3 groups according to number of root (single, two, three-rooted). The measurements were assessed with the Invivo professional software and then, subjected to correlation matrices and linear regression statistical analysis in order to find any significant correlations between crown and root measurements (α≤0.05). RESULTS: Seventy-three out of 247 good quality CBCTs were assessed. Correlation matrices statistical analysis showed linear correlations for some variables investigated, especially for CW/RW pairing in all subgroups (r=0.81, r=0.70 and r=0.58 respectively for single-, two- and three-rooted) and CL/RL in the single-rooted subgroup (r=0.29). Subsequent linear regression analysis allowed to obtain information about roots starting from crown measurements by means of equations [RW=0.76+(0.73×CW) and RL=10.94+(0.25×CL) for single-rooted teeth; RL=1.11+(0.73×CW) and RW=0.99+(0.76×CW), respectively for single- and two-rooted teeth]. No linear correlation was found between crown measurements and C-R angular values. CONCLUSION: It is possible to obtain root information starting from some crown measurements but these do not fulfil the need of minimal information to guarantee a perfect root position starting from that of crown.